Colin Hoobler: Physical therapy can aid obesity treatment

Dear Colin: You've mentioned that physical therapy can be an effective tool to treat obesity -- how? I don't know of any physical therapy clinics that address obesity and as far as I know, insurance doesn't cover physical therapy as part of treatment for obesity. -- Dr. Williams, Internist, Beaverton

Physical therapy serves many different roles depending on the setting and training of the physical therapists.

For example, in the acute care setting (hospitals, for example), the main goals of physical therapy usually involve pain management, wound care, bed mobility and/or gait development after surgery. But in the outpatient orthopedic setting, chronic health problems (including obesity and chronic pain) are addressed primarily through intensive exercise for those with chronic health problems as well as those preparing for/recovering from surgery.

Given the focus on exercise as the main therapy, these physical therapy clinics can be well equipped to help the obese patient with chronic health problems.

This physical therapy approach can be a game changer in a health care system devoid of answers for patients who are severely deconditioned/obese and have chronic health problems. The World Health Organization (2007) considers obesity a global epidemic affecting virtually every age group.

And there's a childhood obesity epidemic in the U.S., which has led to Type 2 diabetes and high blood pressure in kids as young as 10 years old (Journal of the American Medical Association 2006). While it's tempting to write off such data as genetic, research clearly shows it is a behavioral issue that we need to take responsibility for.

And the "we" includes health care providers, especially physical therapists, because we are in a unique position to help obese patients improve their lifestyle habits. Most insurance plans allow us to see them several times per month. And physical therapists can work with patients to develop customized home exercise and nutrition plans they can use for the rest of their lives. The key here is customization; there's no such thing as "one program fits all."

Exercise therapy is a branch of physical therapy that is a billable service when patients demonstrate any musculoskeletal condition that impairs their desired function. While obesity by itself is not a billable code, it almost never exists in isolation. Knee pain, back pain, Type 2 diabetes, osteoarthritis and heart disease are common health problems many deconditioned/obese patients deal with, largely because they lead sedentary lifestyles and make poor food choices (The International Journal of Aging 2008).

Coincidentally, the primary treatment for these and many other musculoskeletal health problems is specific, purposeful exercise that improves joint mechanics while reducing body fat. The exercise therapy plan must incorporate exercises that people can do on their own, whether at home or at their health club, and ensure they're done correctly to minimize injury risk and maximize benefit.

It's up to health care professionals to work diligently with patients to ensure they are becoming more active and making wiser food choices to reduce costs from both human and economic perspectives. -- Colin Hoobler is hosting a charity event, "Overcoming Knee Pain," 9-11 a.m. Jan. 26 at Portland State's Stott Center. To register, visit chpt.org.